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SARS-CoV-2 appeared in Wuhan at the end of 2019 and rapidly spread to the rest of the World. More than 243 million cases of COVID-19 have been confirmed and almost 5 million persons died [1]. The knowledge about the risk associated with severe COVID-19 disease, lung cancer and its treatment is scarce, particularly about radiotherapy (RT). We studied the impact of 1 year of COVID-19 in the RT treatment of lung cancer. We also intended to evaluate the tolerability to RT in patients infected with SARS-CoV-2.

We analyzed medical records relative to the RT department in an oncological center, comparing May/2019-April/2020 to May/2020-April/2021, i.e., the year previous and a year during the pandemic. We collected the patients' demographic and lung cancer characteristics. Patients infected with SARS-CoV-2 previous or during cancer treatment were also registered, as their tolerability to RT. Descriptive and statistical analyses were performed using SPPS software.

228 treatments (206 patients) and 266 treatments (244 patients) were delivered in the year previous and the year with COVID-19, respectively.

The median age was 72.0 years [40-99 years] and 74.3% of patients were men, without difference between groups. Most of the patients presented adenocarcinoma (57.3%), epidermoid (26.9%) and small-lung cancer cell (7.3%).

65% of the patients were referenced to our institution from other hospitals to perform RT. All these hospitals were COVID-19 treatment centers. Nevertheless, no decrease in the number of patients referenced by these institutions was observed.

No difference regarding the clinical stage was found between (42.5% vs 46.6% stage I; 11.0% vs 9.0% stage II; 33.3% vs 28.9% stage III; and 13.2% vs 15.4% stage IV, for pre vs COVID-19 year, respectively).

Most of the patients were treated with SBRT (53.5% vs 53.0%), radical RT (25.9% vs 25.2%), palliative RT (10.1% vs 11.3%) and adjuvant RT (8.3% vs 8.3%, for pre vs COVID-19 year, respectively). RT fractionation schemes were not changed during COVID-19 pandemic.

Ten patients were infected with SARS-CoV-2 previous or during cancer treatment. Six patients were asymptomatic, 2 developed mild symptoms and 2 moderate/severe disease. Half of the diagnoses were performed during cancer treatment, with chemotherapy (ChT) treatment being delayed in 1 patient and omitted the last cycle in 2 patients. RT was interrupted in 2 patients. All patients presented good tolerance to RT treatment (G≤2, CTCAE 5.0). One of the patients with omission of the last cycle of ChT has disease stable at the end of the study, one without information and the remaining have no evidence of active disease.

COVID-19 pandemic is a major threat in the provision of medical services, including management of cancer. Unexpectedly, in our service, the number of treatments of lung cancer was maintained during the pandemic. The patients infected with SARS-CoV-2 presented good tolerance to RT treatment.